Stress-Induced Dermatitis (Hives): Symptoms, Diet, and Remedies

What is Stress-Induced Dermatitis (Hives)?

Atopic dermatitis is a chronic inflammatory skin disease characterized by widespread itching (pruritus) and a clinical course marked by alternating flare-ups and symptom-free periods of remission. While the precise mechanisms that trigger these exacerbations are still not fully understood, one factor is widely recognized by both patients and clinicians: stress along with other forms of psychological distress such as anxiety, is capable of triggering the onset of symptoms and worsening existing skin conditions.

The Biological Link Between Stress and Skin

When the body experiences a stressful situation, it enters what is commonly known as “fight or flight” mode: a primitive survival response designed to prepare the body to confront or escape danger. In this state, the body dramatically increases production of stress hormones, most notably adrenaline (epinephrine) and cortisol.

While adrenaline primarily affects cardiovascular function (increasing heart rate and blood pressure), cortisol is thought to play a particularly important role in triggering dermatitis and urticaria (hives) through several mechanisms:

• Immune suppression: Elevated cortisol levels suppress normal immune function, disrupting the delicate immune balance of the skin. In individuals with atopic dermatitis, the skin’s immune regulation is already compromised, making them particularly vulnerable to this effect.
• Inflammatory response: Paradoxically, while cortisol is anti-inflammatory in the short term, chronic stress leads to a state of systemic low-grade inflammation, promoting inflammatory skin reactions.
• Skin barrier dysfunction: Stress hormones negatively affect the integrity of the skin barrier by reducing production of ceramides and other lipids that keep the skin sealed and hydrated, allowing allergens and irritants to penetrate more easily.
• Neuroinflammation: Stress stimulates the release of neuropeptides (such as substance P) from nerve endings in the skin. These directly trigger mast cell degranulation and histamine release, which is the same pathway involved in hives and itching.

The Vicious Cycle of Stress and Skin Disease

A closer examination of the relationship between anxiety/stress and atopic dermatitis reveals that the connection is far more complex than a simple cause-and-effect dynamic. It is, in fact, bidirectional and self-perpetuating, creating what is often described as a vicious cycle:

1. An external event triggers a state of stress or anxiety.
2. Stress triggers the onset of skin symptoms (itching, redness, rash).
3. The skin symptoms worsen the patient’s perception of stress because the discomfort, embarrassment, disrupted sleep, and social impact of visible skin disease all amplify psychological distress.
4. Worsened stress triggers further skin flares, and the cycle continues.

This self-reinforcing loop explains why managing stress is not merely a complementary measure but a central component of effective atopic dermatitis management.

The Role of Medications

For a minority of patients, the situation is further complicated by the use of montelukast, a drug frequently prescribed to allergic individuals (particularly for allergic rhinitis and asthma). Montelukast is associated with neuropsychiatric side effects including anxiety and depression, which may inadvertently worsen the psychological burden already experienced by patients with atopic skin disease. Patients and caregivers should be aware of this potential interaction and discuss it with their physician.

Other Triggers Worth Knowing

Since stress alone cannot cause the development of atopic eczema (it can only trigger flares in those already predisposed), it is valuable to understand the full range of potential triggering factors to implement the broadest possible preventive approach. Beyond stress, established triggers include:

• Dry skin: The single most important physical factor; regular application of emollient (moisturizing) creams is foundational to prevention
• Irritants: Soaps, detergents, fragrances, cosmetics, synthetic fabrics, and household cleaning products
• Climate: Cold, dry weather is a major trigger; low humidity environments worsen skin barrier function
• Allergens: In predisposed individuals, exposure to environmental allergens such as:
  • Dust mites
  • Pet dander (cat and dog hair/saliva)
  • Pollen
  • Molds
• Hormonal changes: Commonly occurring during pregnancy or in association with premenstrual syndrome (PMS)
• Food allergens: In some patients, particularly children, specific foods can trigger flares (see the diet section below)
• Sweat and heat: Exercise-induced sweating can irritate already sensitized skin
• Infections: Bacterial (Staphylococcus aureus), viral, and fungal skin infections are common complicating triggers in atopic dermatitis

Understanding your personal triggers, ideally with the help of a dermatologist or allergist, is a powerful first step toward better disease control.

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Symptoms

Stress-induced dermatitis and urticaria can manifest with a range of symptoms that vary considerably between individuals and between episodes. The three cardinal symptoms are:

1. Redness (erythema): Areas of inflamed, reddened skin that may appear patchy or widespread
2. Blister formation (vesicles): Small, fluid-filled blisters that develop within or overlying the reddened skin
3. Itching (pruritus): Often intense, and in many cases the most debilitating symptom

Where Do Symptoms Appear?

While symptoms can theoretically develop anywhere on the body, there are characteristic predilection sites that are most commonly affected:

• Hands and fingers (particularly the finger creases and between the fingers)
• Inner elbows (antecubital fossae) and the back of the knees (popliteal fossae): the classic flexural pattern
• Face, especially the cheeks, forehead, and skin around the eyes
• Scalp, particularly in infants and young children
• Neck and upper chest
• Ankles and wrists

In infants, the face, scalp, and trunk are most commonly affected. In children and adults, the flexural areas (inner elbows, back of knees) are more typical.

Severity and Variability

The severity of stress-induced dermatitis is highly variable, not only between different patients but also between different episodes in the same individual. The spectrum ranges from:

Mild cases:

• Small patches of dry, slightly rough skin
• Mild to moderate itching, manageable without treatment
• Minimal impact on daily activities

Moderate cases:

• More extensive areas of redness and blistering
• Significant itching that affects concentration and sleep quality
• Visible skin changes that may cause social embarrassment

Severe cases:

• Involvement of large areas of the body
• Severe, constant, and irresistible itching that causes the patient to scratch until bleeding occurs
• Profoundly disrupted sleep (insomnia)
• Inability to concentrate or perform normal daily activities
• Significant psychological impact (anxiety, depression)
• Risk of secondary skin infections from open wounds caused by scratching

It is worth noting that, for many patients, symptoms tend to diminish in severity with advancing age, although the condition can persist throughout life in some individuals.

Disease Progression Within a Flare-Up

Within a single flare-up episode, the skin changes follow a recognizable pattern:

1. Initial phase: Redness and swelling of the affected skin; onset of itching
2. Active phase: Development of papules (small raised bumps) and vesicles (small blisters); intense pruritus; scratching may cause the blisters to rupture, leading to weeping (oozing of clear fluid) and subsequent crust formation
3. Resolution phase: As the flare subsides, the skin undergoes desquamation (peeling/scaling), which gradually decreases until the skin returns to its baseline appearance
4. Potential relapse: In some patients, apparent recovery is followed by an unexpected and sudden relapse, restarting the cycle

When to Seek Medical Attention

You should consult a doctor promptly if:

• Symptoms are severe, widespread, or rapidly worsening
• The skin shows signs of infection (increasing redness, warmth, swelling, pus, fever)
• Symptoms are significantly affecting your sleep or daily functioning
• Over-the-counter treatments are not providing adequate relief
• You are uncertain about the diagnosis

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How Long Does It Last?

Atopic dermatitis is classified as a chronic condition, one that can potentially persist for years or throughout a person’s lifetime. However, the course of the disease is highly variable and unpredictable, characterized by the alternation of symptomatic flares and symptom-free remissions.

Flare Duration and Frequency

• Acute flare-ups can occur up to 2 or 3 times per month in actively affected individuals, lasting anywhere from a few days to several weeks depending on severity, triggers, and treatment.
• Remission periods, which are intervals with absent or minimal symptoms, can last for months or even years in some patients.

Long-Term Outlook

• In children: Atopic dermatitis is extremely common in childhood (affecting approximately 15–20% of children in developed countries) and frequently improves or resolves as the child grows older. Studies suggest that approximately 50% of children with atopic dermatitis will see significant improvement or complete resolution by adolescence or early adulthood.
• In adults: Some individuals continue to experience flares throughout their adult lives, though many notice a reduction in frequency and severity over time. A minority develop new-onset atopic dermatitis in adulthood.
• Factors associated with persistence: More severe disease in childhood, early onset, family history of atopic disease, co-existing asthma and allergic rhinitis (the “atopic march”), and high levels of chronic stress are associated with a higher likelihood of persistent adult disease.

Understanding the chronic nature of the condition helps patients set realistic expectations and commit to long-term skin care routines and stress management strategies rather than seeking quick fixes.

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Treatment

Managing stress-induced dermatitis effectively requires a dual approach: addressing both the skin disease itself (dermatological management) and the underlying psychological trigger (psychological/psychiatric management). These two approaches are most effective when used in combination.

Dermatological Management

The skin-focused component of treatment encompasses a range of interventions, from basic skin care to prescription medications:

1. Gentle Skin Cleansers

Harsh soaps and conventional body washes strip the skin of its natural protective oils and disrupt the skin barrier. Patients with atopic dermatitis should use:

• Fragrance-free, hypoallergenic cleansers specifically formulated for sensitive or atopic skin
• Syndets (synthetic detergent bars) rather than traditional soap
• Lukewarm water for washing, never hot, as hot water exacerbates dryness and itching

2. Emollients and Moisturizers (Emollient Therapy)

Emollient therapy is the cornerstone of atopic dermatitis management and should be practiced daily, regardless of disease activity:

• Apply immediately after bathing (within 3 minutes, while skin is still slightly damp) to lock in moisture
• Choose fragrance-free, preservative-free formulations (thick creams or ointments are generally more effective than lotions)
• Apply to the entire body, not just visibly affected areas
• Aim for at least twice-daily application during flares; once daily during remission

3. Topical Corticosteroids

For active flares, topical corticosteroids remain one of the most effective treatments:

• Available in different potency classes (mild, moderate, potent, very potent).
• The appropriate potency should be chosen based on the severity of the flare, the age of the patient, and the body area affected (the face and genital areas require only mild steroids).
• Not for long-term continuous use: only for short-term control of active flares, to minimize side effects (skin thinning, striae).

4. Topical Calcineurin Inhibitors (TCIs)

• Tacrolimus ointment and pimecrolimus cream are non-steroidal anti-inflammatory topicals, particularly useful for sensitive skin areas (face, eyelids, genital region) where long-term steroid use is problematic
• Can be used for longer periods than topical steroids without the risk of skin thinning
• Also approved for proactive therapy (twice-weekly application on previously affected areas during remission to prevent flares)

5. Antihistamines

Antihistamine medications can help manage itching, particularly when it is interfering with sleep:

• Sedating antihistamines (e.g., diphenhydramine, hydroxyzine): More helpful for nighttime use due to their sleep-inducing effect
• Non-sedating antihistamines (e.g., cetirizine, loratadine, fexofenadine): Useful for daytime management, particularly when co-existing allergic rhinitis or urticaria is present
• Note: antihistamines have limited efficacy against the itch of atopic dermatitis per se (which is not primarily histamine-mediated) but may help in stress-induced urticaria

6. Systemic Treatments for Moderate-Severe Disease

When topical treatments are insufficient, systemic (oral or injectable) therapies may be required:

• Oral corticosteroids (cortisone): Reserved for short-term management of severe flares; long-term use is associated with significant systemic side effects and is generally avoided
• Cyclosporine: An oral immunosuppressant effective for moderate-to-severe atopic dermatitis; requires regular monitoring of kidney function and blood pressure
• Methotrexate and azathioprine: Other systemic immunosuppressants used in refractory cases
• Dupilumab (Dupixent): A revolutionary biologic agent (monoclonal antibody targeting IL-4 and IL-13 signaling) that has transformed the management of moderate-to-severe atopic dermatitis. Administered by subcutaneous injection every two weeks, it is highly effective and well-tolerated, with no requirement for immune function monitoring.
• JAK inhibitors (e.g., baricitinib, abrocitinib, upadacitinib): A newer class of targeted oral or topical immunomodulators showing excellent efficacy in clinical trials for moderate-to-severe atopic dermatitis

7. Phototherapy

Narrowband UVB phototherapy is an effective treatment option for patients with widespread atopic dermatitis who have not responded adequately to topical therapies. Conducted in a dermatology clinic under medical supervision, it involves controlled exposure to specific wavelengths of ultraviolet light that reduce skin inflammation.

Psychological Management

The psychological component of treatment is equally important as the dermatological approach, yet it is too often underutilized. This is frequently due to unwarranted feelings of shame or embarrassment that prevent patients from seeking mental health support.

1. Cognitive-Behavioral Therapy (CBT)

Cognitive-behavioral therapy is a structured, evidence-based form of psychotherapy that helps patients identify and change unhelpful thought patterns and behaviors that contribute to stress and worsen skin symptoms. Multiple clinical studies have demonstrated that CBT, when used alongside standard medical treatment, produces significantly better outcomes than medical treatment alone. Importantly, this benefit has been demonstrated even when CBT is delivered remotely via digital platforms, as shown in a study published in JAMA Dermatology, making it accessible to patients who cannot easily attend in-person sessions.

CBT for atopic dermatitis specifically targets:

• The “itch-scratch cycle” and habitual scratching behavior
• Anxiety and rumination about the skin condition
• Sleep disturbance
• Social anxiety related to visible skin lesions
• Coping strategies for stress management

2. Habit Reversal Training (HRT)

A specific behavioral technique used alongside CBT to replace scratching with less damaging behaviors (such as pressing or pinching the skin), breaking the itch-scratch cycle.

3. Mindfulness-Based Interventions

Mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT) have been studied in atopic dermatitis with positive results, helping patients develop non-reactive awareness of itching sensations and reducing stress-related disease exacerbation.

4. Psychiatric Medications

In patients with significant anxiety or depression contributing to skin disease flares, pharmacological psychiatric support may be appropriate:

• Antidepressants: Particularly selective serotonin reuptake inhibitors (SSRIs), which have demonstrated both mood-improving and itch-reducing properties in some patients
• Anxiolytics: For the short-term management of acute anxiety
• Always prescribed and monitored by a qualified psychiatrist or physician

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Natural Remedies

Natural and lifestyle-based strategies play a genuinely important role in the long-term management of stress-induced dermatitis. While they do not replace medical treatment in moderate-to-severe cases, they provide a powerful complementary foundation for disease control. For some patients with mild disease, they may even be sufficient on their own.

1. Stress Management and Relaxation Techniques

Learning and consistently practicing relaxation and stress reduction techniques is arguably the most important natural intervention for stress-induced skin disease. The ideal approach is highly individual. What works perfectly for one person may not suit another, and it is worth exploring multiple options to find your personal fit:

• Breathing exercises: Slow, diaphragmatic (abdominal) breathing activates the parasympathetic nervous system, counteracting the fight-or-flight response. Simple techniques like “4-7-8 breathing” or box breathing can be practiced anywhere, anytime.
• Autogenic training: A self-relaxation technique involving the mental repetition of calming phrases associated with physical sensations of warmth and heaviness.
• Meditation: Regular meditation practice, even for 10–15 minutes daily, has robust evidence supporting its stress-reducing and anti-inflammatory effects.
• Yoga: Combines physical movement, breath control, and meditation. Multiple studies support its benefits for stress reduction, anxiety, and quality of life in patients with chronic skin conditions.
• Tai chi and qi gong: Gentle, mindful movement practices with documented stress-reducing benefits, particularly accessible for older patients or those with physical limitations.
• Nature walks (forest bathing / “Shinrin-yoku”): Spending time in natural environments has been shown to reduce cortisol levels, lower heart rate, and improve mood, all of which benefit stress-related skin conditions.
• Volunteering and social contribution: Engaging in meaningful activities for others provides purpose and positive emotion, powerful antidotes to stress.
• Creative hobbies: Art, music, writing, gardening, cooking, or any absorbing creative activity that provides a constructive outlet for tension and negative emotions.

2. Sleep Hygiene

The importance of adequate, quality sleep is frequently underestimated, yet it represents one of the fundamental pillars of stress management and immune regulation. Poor sleep worsens cortisol dysregulation, impairs immune function, and lowers the threshold for stress-triggered skin flares.

Key sleep hygiene practices include:

• Maintaining a consistent sleep schedule (same bedtime and wake time every day, including weekends)
• Creating a cool, dark, quiet sleep environment
• Avoiding screens (phones, tablets, computers) for at least one hour before bed
• Avoiding caffeine after early afternoon
• Developing a calming pre-sleep routine (warm bath, reading, gentle stretching)
• Avoiding alcohol as a sleep aid: while alcohol initially promotes sleep onset, it disrupts sleep architecture and worsens overall sleep quality
• Some patients may benefit from a short afternoon nap (20–30 minutes) to compensate for stress-disrupted nighttime sleep

3. Physical Exercise

Regular physical activity is one of the most powerful and scientifically proven lifestyle interventions for stress reduction, mental health, and overall wellbeing. Its benefits extend far beyond cardiovascular health. Exercise is a genuine, evidence-based anti-stress and anti-inflammatory tool:

• Endorphin release: Physical activity, particularly high-intensity aerobic exercise (where the heart rate is significantly elevated), promotes the release of endorphins. These are brain chemicals that produce feelings of happiness, calm, and wellbeing.
• Cortisol regulation: Regular exercise improves the body’s ability to regulate cortisol levels over time.
• Anti-inflammatory effect: Chronic moderate exercise has systemic anti-inflammatory effects that may benefit the skin.
• Improved sleep: Regular exercisers sleep better, which creates a positive feedback loop between exercise, sleep, and stress management.

Important note for atopic dermatitis patients: Sweating can be a skin trigger in some individuals. If this applies to you:

• Prefer cooler environments for exercise (air-conditioned gym, evening outdoor runs)
• Wear moisture-wicking, soft, non-synthetic clothing
• Take a lukewarm (not hot) shower immediately after exercise to rinse away sweat before it has time to irritate the skin
• Apply emollient cream after the post-exercise shower

Outdoor exercise provides the additional benefits of natural light exposure and nature contact, amplifying the stress-reducing effect.

4. Social Support and Connection

The importance of strong social bonds for both mental and physical health is firmly supported by scientific evidence. This includes data showing that individuals with rich social relationships have significantly longer life expectancy than socially isolated individuals.

For patients with stress-related skin disease:

• Invest in maintaining meaningful relationships with friends and family.
• Seek out or create support groups with others who share the same condition. The experience of being understood by people who truly know what living with a chronic skin disease feels like is profoundly validating and stress-reducing.
• Patient advocacy organizations (such as the National Eczema Association) provide community, education, and advocacy resources

5. Practical Skin Care During Flares

During active flare-ups, simple measures can significantly reduce discomfort and prevent worsening:

• Moisturize the skin at least twice daily, ideally immediately after bathing.
• Limit water exposure: Prolonged contact with water (especially chlorinated pool water or very hard tap water) dries out the skin. Showers are preferable to baths; keep them short (5–10 minutes).
• Use only lukewarm (not hot) water for bathing, as hot water dramatically worsens itching.
• Pat the skin dry gently with a soft towel; never rub.
• Keep nails short and clean to minimize skin damage from inevitable scratching.
• Wear loose, breathable, soft cotton clothing; avoid wool and synthetic fibers directly against the skin.

6. Dilute Bleach Baths

The American Academy of Dermatology (AAD) recommends considering dilute bleach baths as an adjunct measure to help prevent flares and, more importantly, reduce the risk of bacterial skin infections. This is particularly relevant for Staphylococcus aureus colonization, which is extremely common in atopic skin and significantly worsens disease severity.

The Mayo Clinic confirms that an appropriate dilution is:

• ½ cup (approximately 120 ml) of regular household bleach (not concentrated bleach) per 151-liter full bathtub of warm water
• This creates a solution roughly equivalent to a mildly chlorinated swimming pool
• For children, the dose should be reduced proportionally
• Soak for 5–10 minutes, then rinse with clean water and apply emollient cream immediately
• Do not use on broken or infected skin without medical supervision
• Always consult your doctor before starting bleach baths, particularly for children

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Foods to Avoid and Diet

Diet is the third essential pillar of a healthy lifestyle and a logical target for intervention in stress-related skin disease. While there is no single universally established “anti-eczema diet”, diet plays a meaningful role in overall inflammation levels, immune function, and gut health, all of which influence skin disease.

The Mediterranean Diet as a Starting Point

Current evidence consistently supports the Mediterranean diet as an excellent nutritional model that reduces systemic inflammation. This makes it a logical and well-tolerated dietary foundation for patients with atopic dermatitis. Despite the fact that the term “Mediterranean diet” can be vague, its core principles are well-defined:

Foods to emphasize:

• Abundant fresh fruits and vegetables: Rich in antioxidants (vitamins C, E, beta-carotene), polyphenols, and fiber, all of which have anti-inflammatory properties.
• Whole grains: Brown rice, whole wheat pasta and bread, oats, and quinoa provide fiber and micronutrients while stabilizing blood sugar.
• Legumes: Lentils, chickpeas, beans, and peas are excellent plant-based sources of protein and fiber.
• Nuts and seeds: Walnuts, almonds, flaxseeds, and chia seeds are rich in omega-3 fatty acids and anti-inflammatory compounds.
• Fish: Particularly fatty fish (such as salmon, sardines, mackerel, herring, and anchovies), which are the richest dietary sources of omega-3 fatty acids (EPA and DHA). These have potent anti-inflammatory effects and have been specifically studied in atopic dermatitis.
• Olive oil: Extra virgin olive oil as the primary fat source, which is rich in oleocanthal (a natural anti-inflammatory) and monounsaturated fats.
• Low-fat dairy products: In moderation; probiotic-containing options (yogurt, kefir) may have additional benefits for gut and immune health.

Foods to limit or avoid:

• Processed and ultra-processed foods: Often high in refined sugars, trans fats, artificial additives, and salt, all of which are pro-inflammatory.
• Red and processed meats: Associated with higher inflammatory markers; if consuming meat, choose lean cuts in small quantities.
• Refined sugars and sweetened beverages: Promote inflammation and may worsen the gut microbiome composition.
• Alcohol: Promotes inflammation, disrupts sleep, and impairs immune function, a triple threat for atopic dermatitis patients.

Food Allergens

A critical consideration for many patients with atopic dermatitis, particularly children, is the role of food allergies in triggering skin flares. The most common food allergens in atopic dermatitis include:

• Cow’s milk / dairy products
• Hen’s eggs
• Peanuts and tree nuts
• Wheat and gluten-containing grains
• Soy
• Fish and shellfish

Important: The identification of relevant food triggers should be based on validated, scientifically sound diagnostic approaches, as discussed in detail in this article on allergy and food intolerance testing. Unscientific elimination diets based on unvalidated tests (such as IgG food panels, hair analysis, or kinesiology) can lead to unnecessary, potentially harmful dietary restrictions that deprive patients of essential nutrients without therapeutic benefit.

The gold standard for identifying food triggers in atopic dermatitis involves:

1. Detailed dietary history and food-symptom diary
2. Standardized allergy testing (skin prick tests, specific IgE blood tests)
3. Supervised elimination diet followed by controlled food reintroduction challenges, ideally under the guidance of an allergist and dietitian

Anti-Inflammatory Foods: A Closer Look

Beyond the broad Mediterranean dietary framework, some specific anti-inflammatory foods and nutrients deserve special mention for their potential benefits in atopic dermatitis:

Low-Histamine Diet

Some patients with atopic dermatitis or chronic urticaria may benefit from a low-histamine diet, particularly during periods of active flares. Histamine is a naturally occurring compound found in many foods and produced by bacteria during fermentation and aging processes; in individuals with reduced histamine-degrading enzyme activity (histamine intolerance), dietary histamine can exacerbate skin symptoms.

High-histamine foods to potentially reduce during flares include:

• Aged cheeses
• Fermented products (wine, beer, vinegar, sauerkraut, soy sauce, miso)
• Smoked and cured meats
• Canned and preserved fish
• Certain vegetables (tomatoes, spinach, eggplant, avocado)
• Alcohol

However, a strict low-histamine diet is challenging to maintain, nutritionally restrictive, and not universally beneficial. It helps some patients significantly while making no difference to others. It is therefore strongly recommended to pursue this dietary approach under the guidance of a qualified dietitian and allergist, rather than self-imposing sweeping restrictions that may unnecessarily limit nutritional intake.

Additionally, it is worth exploring whether a diagnosis of histamine intolerance is clinically supported before committing to long-term dietary changes.

Hydration

Adequate hydration is a simple yet important measure for maintaining skin moisture from the inside:

• Aim for at least 6–8 glasses (1.5–2 liters) of water per day
• Increase intake during hot weather or physical activity
• Herbal teas (chamomile, green tea) can contribute to fluid intake and offer additional anti-inflammatory benefits

Gut Microbiome and the Gut-Skin Axis

Emerging research highlights the importance of the gut-skin axis, the bidirectional communication between the intestinal microbiome and skin immune function, in atopic dermatitis. Patients with atopic dermatitis frequently show altered gut microbiome composition (dysbiosis) compared to healthy controls. While this field is still developing, current evidence supports:

• Consuming a diverse, plant-rich diet to support microbiome diversity
• Including probiotic and prebiotic foods regularly
• Avoiding antibiotic overuse, which disrupts the microbiome
• Discussing probiotic supplementation with your doctor, particularly during and after antibiotic courses

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Sources and Bibliography

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• National Eczema Association. Eczema and Emotional Wellness.
• Cleveland Clinic. How Stress Causes Eczema.
• American Academy of Dermatology. Bleach Bath Recommendations for Eczema.
• Mayo Clinic. Atopic Dermatitis (Eczema) – Symptoms and Causes.
• Walling HW, Swick BL. Update on the management of chronic eczema: new approaches and emerging treatment options. Clin Cosmet Investig Dermatol. 2010;3:99-117.
• Holt-Lunstad J, Smith TB, Layton JB. Social relationships and mortality risk: a meta-analytic review. PLoS Med. 2010;7(7):e1000316. https://pubmed.ncbi.nlm.nih.gov/26729882/
• Weidinger S, Beck LA, Bieber T, Kabashima K, Irvine AD. Atopic dermatitis. Nat Rev Dis Primers. 2018;4(1):1.
• Ring J, Alomar A, Bieber T, et al. Guidelines for treatment of atopic eczema (atopic dermatitis). J Eur Acad Dermatol Venereol. 2012;26(8):1045-1060.
• Arck PC, Slominski A, Theoharides TC, Peters EM, Paus R. Neuroimmunology of stress: skin takes center stage. J Invest Dermatol. 2006;126(8):1697-1704.
• Silverberg JI, Hanifin J, Simpson EL. Climatic factors are associated with childhood eczema prevalence in the United States. J Invest Dermatol. 2013;133(7):1752-1759.